Prostate Cancer Awareness Month Feature
Guests: Bob Terravecchia & Dr. Clifford Gluck
Hosted by Rob Hakala & Beth Foster
Aired on 95.9 WATD, South Shore
Listen to the Podcast:
Rob Hakala (Host)
(00:01) Welcome to the South Shore’s Morning News Week in Review podcast. I’m Rob Hakala.
Beth Foster (Co-Host)
(00:06) And I’m Beth Foster. Each week, we listen back to some of our favorite interviews and moments on the South Shore’s Morning News.
Rob Hakala
(00:13) Which airs weekdays from 5 to 10 AM on 95.9 WATD. Great to have you along. Yeah, it’s a Thursday and that means we do indeed check in with Bob Terravecchia. Bob joins us every week at this time. CEO Chair of Coastal Heritage Bank. This segment is proudly presented by Coastal Heritage Bank — one community, many individuals, one bank that is perfect for you. Coastal Heritage Bank: growing together. Member FDIC, Member DIF.
Bob, good morning.
Bob Terravecchia (CEO, Coastal Heritage Bank)
(00:57) How you doing today?
Rob Hakala
(00:58) Doing great. How’ve you been, Bob?
Bob Terravecchia
(01:01) Doing great. You gotta love this beautiful weather we’re having here — late summer stretch.
Rob Hakala
(01:07) I know, it really is. And speaking of September, this is something we wanted to highlight. Bob has a special guest with him on the phone this week for our Coastal Heritage segment. Right, Bob?
Bob Terravecchia
(01:21) I do, yes, indeed. I’d like to introduce everybody to Dr. Clifford Gluck, a well-renowned urologist here on the South Shore.
And before I give him the microphone, I just want to talk about Prostate Cancer Awareness Month — which September is, Robert. We’ve talked about this over the last couple of years. Dr. Gluck is my urologist for my journey through prostate cancer, which I was diagnosed with three years ago. He’s a staunch advocate for prostate cancer awareness and screening. He’s a great advocate, and I’d like to turn it over to Dr. Gluck.
Rob Hakala
(02:07) Dr. Clifford Gluck, good morning.
Dr. Clifford Gluck (Board-Certified Urologist)
(02:09) Good morning. Thank you for having me on.
Rob Hakala
(02:11) Absolutely. This is an important topic. So Dr. Gluck, what would you like to start with when it comes to prostate cancer awareness and our health?
Dr. Clifford Gluck
(02:23) Well, I think probably the most important thing is the word awareness. Prostate cancer awareness began after the FDA approved the PSA test. PSA is the blood test which can help us to discover and to monitor prostate cancer. Now some people say it’s an imperfect test but PSA is really historically the best test we have in order to help facilitate the diagnosis of prostate cancer. FDA first approved PSA in 1986 and that was for men who had prostate cancer to try to monitor them. Then in 1994, it actually approved PSA for screening purposes to be used along with digital rectal exam. At that time, we started doing large groups of men, usually free screenings all over America which led to an increase in the diagnosis of early prostate cancer. And what’s important about early prostate cancer is that’s the best time to find it. It’s not when it’s already grown too large to remove or spread throughout the body, it’s when it’s early we can actually treat and cure prostate cancer. Before PSA testing, it was very unusual to find early prostate cancer because it’s asymptomatic. You never know it’s there until late in the disease. So without PSA and without rectal exam, it was very difficult to find early prostate cancer. If you had to rely solely on the rectal exam, you would only find about somewhere between a quarter and a third of early prostate cancers. And even those prostate cancers were more advanced than the ones found by PSA.
Rob Hakala
(04:11) So now, when do people get the early screening? It’s great to know that they can do that — how soon should they start?
Dr. Clifford Gluck
(04:21) That’s a very good question. Most men should start screening at age 50, but if you have a family history of prostate cancer, or if you’re in one of the higher risk groups, mainly African American men, men of color, then you should start screening at age 40. And the screening should take place every year. And the most important thing about screening every year is comparing your PSA year to year, because the PSA number should not increase by 0.75 in a year. If it does, that’s a red flag, and it may lead to more testing.
Rob Hakala
(04:59) 0.75 — that’s it?
Dr. Clifford Gluck
(05:02) That’s it. So if your PSA is 2 this year and next year it’s 3, then that’s suspicious and it needs to be followed up on with a urologist.
Bob Terravecchia
(05:13) Now Robert, if I may jump in. Yeah, go ahead Bob. That’s the exact situation that happened with me with Dr. Gluck. I had gone to see Dr. Gluck in consecutive years. My number, and Dr. Gluck, maybe you could just illuminate a little bit on that. They say that it’s a four, and if it’s under four, you’re okay. Well, that was not the case in my situation. I was under a four, and Dr. Gluck was astute enough to say he did not like the fact that my PSA had jumped by a certain percentage.
Dr. Clifford Gluck
(05:43) That’s right. Originally, when the PSA test was developed and an immunoassay was In other words, there was a lab test that we could do to look at the blood and how much PSA was in blood. There was sort of a bell curve drawn to look at all men, and they came up with arbitrary numbers saying that if you were below four, you were okay. If you were above four, that was abnormal. And then that was further refined by age to say if you were above 6.5 after the age of 60, then that was abnormal and so forth. But the real test of PSA is that year-to-year test to see how it changes over time. If you’ve never had a PSA before and it comes in at a higher number, that is suspicious and that does need to be followed up on. The problem that we’ve encountered in society was that so many men were being cured of prostate cancer that people became concerned over the possible complications from treatment. So the two treatments that were available were either a radical prostatectomy, removing the whole prostate gland, and that led to a high incidence of incontinence and erectile dysfunction. or radiation therapy which also led to incontinence and erectile dysfunction as well as sometimes a secondary cancer such as a bladder cancer or other problems with radiation. Now those techniques have been refined greatly over the years and they’re much much better than they used to be but there’s still concern over these complications. So the U.S. Preventative Services Task Force looked at this and in 2012, they came up with a recommendation against PSA screening for all ages based on the harms were greater than the benefits. They gave it a grade D. And this, I should say, horrified the urological community to say, boy, we’re not going to screen men for early prostate cancer. What’s going to happen? And what happened is that men stopped getting rectal exams and they stopped getting PSAs. And then men stopped getting early diagnosis of prostate cancer, and they started showing up with a late diagnosis, much like President Biden showed up with metastatic prostate cancer. So the whole reason of talking about not screening was to prevent complications. And even when we found prostate cancer, even if we found early prostate cancer, if it was a quote unquote more benign type of prostate cancer or a lower grade prostate cancer, the recommendation came out for something called active surveillance. Active surveillance meant, hey, let’s keep an eye on it, but let’s not treat it. But it’s unfortunate. If we follow men for 20 years on active surveillance, we know that two-thirds of them within five years are going to have progression of their disease and at the time of treatment, one quarter of those men are going to have metastatic disease. So it’s really a roll of the dice to do active surveillance. In my opinion, the best time to cure cancer is when you find it and before it’s grown and before it’s spread.
Rob Hakala
(09:04) So it sounds like, Dr. Gluck, you’re saying again to get that baseline as soon as you’re 50. And then if there is another area that maybe you’re more prone to get it sooner, can people get it into their 40s?
Dr. Clifford Gluck
(09:19) People can get it anytime they think they need it. So they don’t have to go with these guidelines. These guidelines just mean recommendations. They don’t mean the conversation that a patient has with their doctor if they think that there’s a concern, then they should express that concern and speak with the doctor about it. Another important thing to think about with active surveillance is that the societies that recommend active surveillance never considered any other treatment besides radiation and surgery. What they didn’t consider is something called HIFU, high-intensity focused ultrasound. HIFU has almost no complications. It’s a very low risk of either erectile dysfunction or incontinence with HIFU. It’s a two-hour outpatient procedure. It’s non-invasive. It’s done just with ultrasound. There’s no cutting and the results from HIFU are equivalent to surgery for most prostate cancer. So this is something that really has not been well recognized by the American medical community. where it’s been in Europe for more than 30 years and all over the world and it is standard of care in most other countries but for whatever reason I, you know, I don’t want to suppose, but there’s a lot of people invested in doing surgery and radiation, and that seems to be what gets recommended to most people.
Rob Hakala
(10:48) How do you spell it?
Dr. Clifford Gluck
(10:51) Sure. HIFU. H-I-F-U. High Intensity Focused Ultrasound. Okay. just like using the energy of the sun with a magnifying glass, you can focus an ultrasound beam, this benign energy that we use to look at a baby in utero, but if you focus it, it becomes very, very powerful and also very exact. We can precisely direct it within a millimeter of where it should be. And that way we can avoid vital structures, vital structures like the nerves of erection, which we could actually see during the procedure that we do or the sphincter muscle or the bladder neck.
Rob Hakala
(11:31) So doctor, let me just ask, as I know, I know we’re running out of time and Bob, you’re here. So if somebody goes and they get the screening and they see the levels are of concern, can they, can they ask, can you, can you get this procedure in this area?
Dr. Clifford Gluck
(11:46) Yes. Yes, I do it. I’ve been doing it for a number of years, even before FDA approval here in America. So, We were doing them overseas before that.
Bob Terravecchia
(11:57) And Robert, I am one of Dr. Gluck’s successful HIFU patients. I had that procedure done three years ago in September. As a matter of fact, Dr. Gluck, it’s been three years. I’m just so blessed that I found Dr. Gluck who’s such a caring and compassionate and highly qualified and competent person that really compassionately guided me and my family through this journey. And I’m just so happy that I was able to share his expertise with you and your WATD community.
Rob Hakala
(12:26) No, we appreciate that, Bob. And I don’t know if you want to share or not, but did you, did you have this level? Was it something you got as part of a regular checkup or were you guys concerned?
Bob Terravecchia
(12:35) You know, I had gone to Dr. Gluck for another matter and I went back for a follow-up. No, this is great. I went back for a follow-up a year later. And as a matter of fact, Dr. Gluck’s office called and, you know, I had made the appointment on the way out. I remember talking to Dr. Gluck, my grandfather had died of prostate cancer and he had done the blood test and, uh, I said, hey, should I, at my age, and I was in my late 50s, should I see a urologist every year? And he said, it wouldn’t hurt. So I made the appointment on the way out the door. And a year later, his office called and reminded me of the appointment. And I remember telling my wife about it. And I said, I’m not having any problems. I’m not going to go back. And she said, why don’t you just go? So I went. I got the blood test, met with Dr. Gluck. And he just kept asking me questions and said, listen, the increase in the PSA, it was concerning. And I remember you said to me, Dr. Gluck, if you were my brother, I’d tell you to get an MRI. And then I came back with the MRI and he said, I think you should get a biopsy. And he was always very measured, never alarmist, said it’s most likely nothing, but it could be something. And as we probed it and probed it, we discovered what it was. And I was lucky enough that I went through the high food treatment with Dr. Gluck. And I couldn’t be more grateful. And I’m just so pleased that I found this early. Because I know how it was with my grandfather. And Dr. Gluck told me, and I know metastatic prostate cancer is a very, very serious disease
Dr. Clifford Gluck
(14:09) And you were a great patient. A lot of men are they’re worried about seeing a urologist, they’re worried about seeing a doctor, and they’re worried about having a rectal exam. And it’s something that, it’s a natural thing. It’s a part of a physical examination. And nothing to be afraid of.
Rob Hakala
(14:33) Well, this has been a great segment to talk about, and it’s so important. And I certainly know that, Bob. As you know, I’m in the 50 club now, 51 technically. And so I’m definitely going through all the levels with my doctor. And thankfully, he said everything was pretty good so far. But we’re going to be continuing to stay on top of everything. And it’s good to really know. And that’s the thing that Dr. Gluck said, awareness. So make sure you talk about it. And then also know what’s available and what you can do. And this has been really important, I think, to talk about for both of you, Bob Teravecchia and Dr. Clifford Gluck.
Bob Terravecchia
(15:09) Thank you so much, Robert.
Dr. Clifford Gluck
(15:12) Thank you. Thank you both.
Rob Hakala
(15:14) And that’s our Coastal Heritage Bank segment this week, recognizing Prostate Cancer Awareness Month — September. 95.9 WATD.